Surgery-related complications and sequelae in management of tuberculosis of spine

Abstract

Study design: Medical record-based survey.

Purpose: To survey the overall incidence of the intra- and postoperative complications and sequelae, and to propose the preventive measures to reduce complications in the spinal tuberculosis surgery.

Overview of literature: There is no study focused on the surgery-related complications and sequelae, with some touching lightly on the clinical problems.

Methods: There were 901 patients in this study, including 92 paraplegics. One hundred eighty-six patients had no visible deformity, while those of 715 patients were visible. Six hundred fifty-nine patients had slight to moderate non-rigid kyphosis, and 56 had severe rigid kyphosis. Sixty-seven out of 92 paraplegics had slight to moderate non-rigid kyphosis, and 25 had severe kyphosis. There were 134 cervical and cervicodorsal lesions, 518 thoracic and thoracolumbar lesions, and 249 lumbar and lumbosacral lesions. Seven hundred sixty-four patients had primarily anterior surgeries, and 137 had posterior surgeries. Instrumentation surgery was combined in 174 patients.

Results: There were intra- and postoperative complications: direct large vessel and neurological injuries (cord, roots, nerves), late thrombophlebitis, various thoracic cavity problems, esophagus and ureter injuries, peritoneum perforation, ileus, wound infections, stabilization failure, increase of deformity and late adjacent joint and bone problems. Thrombophlebitis and sympatheticolysis symptoms and signs in the lower limbs were the most common complications related with anterior lumbar and lumbosacral surgeries. Kyphosis increased in 31.5% of the non-instrumented anterior surgery cases (42% in children and 21% in adults).

Conclusions: The safe, effective and most familiar surgical procedure should be adopted to minimize complications and sequelae. Cosmetic spinal surgery should be withheld if functional improvement could not be expected.

Keywords: Complications; Spine; Surgery; Therapeutics; Tuberculosis.

Fig. 1

(A) A malpositioned obliquely tilted strut graft in the neural canal at the time of anterior radical surgery for the tuberculosis of T_11-12. (B) The malpositioned graft was repositioned between T_11-12 more anteriorly (C), which was well incorporated with the graft beds (D, E). Arrow indicates the grafted site. AIF, anterior interbody fusion.

Fig. 2

(A) Tuberculous kyphosis at T_11-12 in a 6-year-old boy was posteriorly stabilized with two Rush nails and segmental wiring between T₉-L₁, under the cover of the triple chemotherapy (INH, rifampin, ethambutol). (B) Tuberculosis was well-cured, but the tip of the inferiorly migrated Rush nail caused pain in the back with a slight progress of kyphosis. (C) The fixation devices were removed, as it did not perform. After removal of the instrument, kyphosis progressed further because of the residual wedging of the diseased vertebra.

Fig. 3

A 55-year-old lady with tuberculosis of C_5-7 (A) for which anterior radical debridement and fusion with an iliac strut graft (B) were performed, under the cover of triple antituberculous medication. The lower end of the iliac strut graft slipped out from the graft bed of C₇ (C). It healed with solid consolidation without causing respiratory difficulty and dysphagia (D, E).

Fig. 4

Adjacent joint disease after Harrington's distraction instrumentation. Posteriorly fused L₂-S₁ with flat back deformity and anteriorly fused L_3-4 and hyperextended T₁₂-L₁ and L₁-L₂ are shown. Positive sagittal balance is shown.